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Chapter 8:
 Intestinal Ischemia
Sections:
Index
Acknowledgements
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Chapter 8 Workbook

LEARNER OBJECTIVES

At the completion of this chapter, the learner will be able to:

Section 1: Introduction
1.0 Explain when intestinal ischemia occurs. 

Section 2: Classification of Intestinal Ischemia
2.0 Describe the classification system for ischemic bowel disease.

  Section 3: Mesenteric Vasculature
3.0 Explain the anatomy and physiology of splanchnic circulation.
3.1 Describe the pathophysiology of ischemic bowel disease.

Section 4: Acute Mesenteric Arterial Occlusion
4.0 Describe the clinical presentation of acute mesenteric arterial
      occlusion (ischemia).
4.1 Discuss the different imaging techniques used in acute mesenteric
      ischemia.
4.2 Explain the treatment protocol for acute mesenteric arterial ischemia.
4.3 Define papaverine infusion.
4.4 Discuss the role of surgery in acute mesenteric arterial ischemia.

Section 5: Acute Mesenteric Venous Occlusion
5.0 Describe the clinical presentation of acute mesenteric venous occlusion
      (ischemia).
5.1 Explain the treatment protocol for acute mesenteric venous ischemia.

Section 6: Chronic Mesenteric Ischemia
6.0 Discuss the clinical presentation and treatment of chronic mesenteric
      ischemia. 

Section 7: Nongangrenous Ischemic Bowel Disease
7.0 Describe the etiology of nongangrenous ischemic bowel disease.
7.1 List the causes of nonocclusive ischemic bowel disease.
7.2 Discuss the pathogenesis of nongangrenous ischemic colitis.
7.3 Describe the classical presentation of nongangrenous ischemic colitis.
7.4 Explain the procedures used in diagnosing nongangrenous ischemic colitis.
7.5 Explain treatment protocols for nongangrenous ischemic colitis.

LEARNER WORKBOOK

EXERCISE 1
1.0 When does intestinal ischemia occur?

2.0 Ischemic bowel disease is classified according to the size and type
      of the vessel(s) that are hypoperfused or occluded. Briefly describe this
      classification system. 3.0 The blood flow to the splanchnic organs is derived from three main
      arterial trunks. What are these?

3.1 Briefly describe splanchnic circulation. 3.2 Identify the following statements as True or False:
     a. The mesenteric circulation receives approximately 50% of the cardiac output. T      F
     b. The larger the artery, the greater its ability to effect vascular resistance. T      F
     c. The most important control mechanisms of splanchnic blood flow are the sympathetic nervous system, humoral factors and local factors.
T
     F
3.3 Briefly describe the pathophysiology of ischemic bowel disease.

EXERCISE 2
4.1 What is the clinical presentation of acute arterial ischemic bowel disease?

4.2 Briefly discuss the different imaging techniques used in acute mesenteric
      arterial ischemia. 4.3 Outline the algorithm recommended for the treatment of acute mesenteric
      arterial ischemia. 4.4 What is papaverine and how is it administered?? 5.0 Which is more frequent - ischemia of mesenteric arterial origin or venous
      origin? 5.1 How is venous intestinal ischemia treated? 6.0 Briefly describe the clinical presentation and treatment of chronic
      mesenteric ischemia. EXERCISE 3
7.0 What is nongangrenous ischemic bowel disease? 7.1 List the causes of nonocclusive ischemic bowel disease according to
      the following categories: 7.2  a. What are the two major forms of colonic ischemia?
       b. Briefly describe each. 7.3. What is the clinical presentation of nongangrenous ischemic colitis? 7.4. Describe the diagnostic procedures used in diagnosing nongangrenous
       ischemic colitis. 7.5. How is nongangrenous ischemic colitis treated?
 

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